上行結腸にみられたNSAID潰瘍の1例

Nonsteroidal Anti-inflammatory Drug (NSAID)-induced Ascending Colonic Ulcer Whose Progress was able to be Observed, Report of a Case

要旨　患者は50歳，女性．約10年前から掌蹠膿疱症性関節炎のためdiclofenac sodium(Voltaren錠^®)を内服していた．また2003年に潰瘍性大腸炎(左側大腸炎型)を発症し加療中であった．2005年6月に血便と発熱を主訴に近医を受診した．Voltaren錠^®による潰瘍性大腸炎の増悪を疑われ，内服中止を指示され当院に紹介となった．当院入院時には症状は改善傾向であった．注腸検査では上行結腸にapple coreのような狭窄を認めた．大腸内視鏡にて上行結腸に全周性の潰瘍を認めた．生検では特異的炎症所見はみられなかった．50日後の注腸検査および大腸内視鏡検査では上行結腸に輪状の潰瘍瘢痕を認めた．経過よりNSAID起因性大腸病変の潰瘍型と考えられた．

　The patient was a 50-year-old woman. She took diclofenac sodium for ten years. In addition, she developed ulcerative colitis (left side type) in 2003. She visited a Clinic, complaining of hematochezia and fever. Exacerbation of ulcerative colitis by diclofenac sodium was suspected and the diclofenac treatment was tarminated before she was introduced to this hospital. At the time of her hospitalization, her symptom was showing signs of improvement. The barium enema picture showed stenosis with an apple core appearance in the ascending colon. The endoscopic picture showed a circular ulcer in the ascending colon. A biopsy specimen didn't show any specific inflammation. The barium enema and the endoscopic picture after the 50th day showed a circular ulcer scar in the ascending colon. It was suspected that our observations show the progress of a NSAID ulcer.